AZ cuts left woman to struggle on own

Brother says sister might still be alive if she had received needed meds, case-manager help

Stephanie Innes Arizona Daily Star

Apr 18, 2011

Submitted Photo

Monica Stefanov struggled for 30 years with mental illness.

On the morning of Jan. 8 - as Tucson was stunned by a mass
shooting that killed six people and injured 13 - 40-year-old Monica
Stefanov lay dying of an overdose inside a Sierra Vista home.

Her death followed a 30-year battle with serious mental illness
- she'd been diagnosed with both bipolar and schizoaffective
disorders.

People with mental illness tend to live shorter lives than those
who don't - they are more likely to end up homeless and without
health care, for one thing. They are also prone to killing
themselves.

But Stefanov had more than mental illness working against her.
She lived in Arizona, a state that jails or imprisons nine times
more people with severe mental illness than it hospitalizes - the
second-worst rate in the nation, says the nonprofit, Virginia-based
Treatment Advocacy Center, which aims to improve treatment for
mental illness.

A friend used a largely unknown Arizona law to force Stefanov
into mental-health treatment, but she was released after five
days.

What ultimately pushed Stefanov over the edge, her family says,
was yet another cut to the state's behavioral health system. Last
July, the state stopped funding case managers, therapeutic support
and virtually all brand-name medication for the 28,000 seriously
mentally ill Arizonans not enrolled in Medicaid. Stefanov didn't
qualify for the health-care program for the state's poorest
residents because her Social Security disability checks paid
slightly more than the $10,830 per year general cap for a single
person.

But the state still provided her services like group therapy,
medication coverage and a case manager. Once those services stopped
as part of massive state budget cuts, she was left alone with
increasingly disturbing thoughts.

"I believe my sister would probably still be alive today if
she'd gotten the service she'd needed," said Eric Harris, 31,
Stefanov's younger brother. "July 1 came around and she had the
carpet ripped out from under her. She suddenly had to do everything
herself."

Since fiscal 2008 the state has cut 52 percent of its funding to
non-Medicaid patients - a huge hit because so many people with
mental illness, like Stefanov, earn too much from Social Security
Disability to qualify for Medicaid, said Dr. Virgil Hancock, chief
of psychiatry for Carondelet St. Joseph's and St. Mary's hospitals
in Tucson.

Hancock said his two hospitals' emergency rooms are doing about
900 psychiatric consultations per month - an increase of about 25
percent from a year ago, he said. Many of the most severely
mentally ill patients are in worse shape than their peers on
Medicaid - who still have mental health services - because they
have been sick for so long that they qualify for disability
benefits from Social Security, pushing them a few dollars over the
Medicaid eligibility cap.

"It's been horrific," Hancock said. "They ended up disenrolling
the sickest patients in the system."

ANGER, HOSTILITY

Diagnosed with bipolar disorder as a child, Stefanov's life had
never been easy. While she could be a loving girl who adored
animals, she had anger and hostility her family didn't understand.
She once threw lit matches at her grandmother. She would get into
fights, beating other children bloody.

"We didn't really talk about it. She was just crazy. You left it
at that," said Harris, who heads a nonprofit agency in Sierra Vista
that provides transportation to disabled and elderly people.

Stefanov grew up mostly in Tucson and dropped out of Catalina
High School after several hospitalizations for psychiatric
problems. She had a baby at age 16, which her parents raised.

At times in her life Stefanov kept her illness mostly under
wraps. She worked for more than five years in tech support at
America Online in Tucson. She also worked as a nursing assistant
and a waitress, and was married twice.

But between her stable periods, she had bouts of self-medicating
with drugs and would go through phases of heavy drinking. When she
got older, she was diagnosed with schizoaffective disorder, which
causes both mood problems and a loss of contact with reality.

In 2008 she tried to kill herself by overdosing on pills after
she misplaced $100. She later told her family that losing the money
showed she wasn't capable of anything.

COVERAGE STOPPED

By the spring of 2010, Stefanov was living with her two dogs in
an apartment in Sierra Vista and attending computer and
self-defense classes at Cochise College. Her family was hopeful
that she was in a better place.

"She wasn't working, but she was functioning," Harris said. "She
didn't rely on anyone for anything. She loved her dogs. She often
would say she liked animals better than people. I think she felt
the animals were more understanding."

On July 1, the state stopped covering the drug Invega, which had
helped with Stefanov's psychoses. The drug has no generic version,
so she went on a generic version of Risperidol.

Soon, she began developing conspiracy theories. She told her
family that someone was following her wherever she went. She
accused her neighbors of watching her and believed they were
working with the FBI. She began calling the sheriff's department,
reporting the presence of people who didn't exist.

After one of those calls, on Oct. 9, deputies arrested her for
false reporting. She was released the same day and her family sent
her to a friend's in Tucson, believing they shouldn't leave her
alone. While shopping with her friend, Stefanov began ducking
behind clothing racks, saying the people who had been following her
in Sierra Vista were in the store, and that they were trying to get
her.

Her friend filled out a petition to get Stefanov court-ordered
treatment, and a judge ordered her into University Physicians
Healthcare Hospital at Kino. When she was released after five days
of treatment, she had no case manager to speak on her behalf, or to
help her find a better medication.

"All these individuals have the same characteristic situation -
many have been very ill, have recovered to some extent with the
help of medication and support and in one fell swoop it was taken
away," said H. Clarke Romans executive director of the National
Alliance on Mental Illness/Southern Arizona. "There are lots of
people like Monica who are marginalized and could easily fall off
that edge."

THREATENED NEIGHBOR

After her release from UPH, Stefanov's condition worsened. On
the Saturday after Thanksgiving, she crawled through a neighbors'
dog door and held the neighbor up against a wall, threatening to
kill her. She demanded to know the location of listening devices
she believed had been planted in her apartment. She was arrested
and sat in the Cochise County Jail until Jan. 5, when a judge
ordered her to outpatient mental health treatment.

Evicted from her apartment and staying with her brother,
Stefanov ended up in the emergency room after drinking an entire
bottle of Nyquil to treat an upper respiratory illness.

She told doctors she had AIDS, and said they were lying when
they told her she was fine to go home.

Angry, she stayed in bed most of the day Friday and on Saturday,
Jan. 8, Harris asked another sister to watch Stefanov while he went
to his parents' house with his wife.

About 30 minutes after he left - around 9:30 a.m. - his sister
called to say Stefanov wasn't breathing. The Medical Examiner's
report said she had Nyquil, Benadryl and a high amount of
amphetamines in her system when she died.

"I was sitting in the ER and I got a text message about
everything going on in Tucson," Harris said. "But it was hard for
me to think about anything but my sister."